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EVALUATION OF BLOOD GAS INSTRUMENTS WITH 6 SIGMA METHODOLOGY

Year 2025, Volume: 16 Issue: 2, 174 - 181, 10.04.2025

Çoskun Çavuşoğlu

https://doi.org/10.31067/acusaglik.1590729

Abstract

Purpose : 6 sigma is one of the most effective quality tools for demonstrating laboratory analytical performance. 6 sigma tells us what level we are at and what rules to follow in case of poor performance. Blood gas analysis plays an important role in the assessment of critical illness, determining the aetiology and severity of disease. In our study, we aimed to evaluate the test performance of blood gas instruments in our hospital with 6 sigma methodology.
Methods : The study included pH, pO2, pCO2, glucose, lactate, ionised Ca, Na, K and Cl parameters analysed on Siemens RAPIDpoint 500e blood gas instruments in the emergency laboratory. In the sigma metric calculation TEa (total permissible error) rates, the values determined by RiliBAK (German Guidelines for Quality) were used. The causes of errors of poorly performing tests were evaluated with the quality goal index (QGI).
Results : At the results, PCO2 (Level 2) in Instrument I, Lactate (Level 1-2) in Instrument II and pCO2 (Level 1-2) in Instrument III are the tests with sigma values below 4. When we look at the low performance problems, precision in Instrument I pCO2 (Level 2), accuracy in Instrument II lactate (Level 1-2) and accuracy in Instrument III pCO2 (Level 1-2) were detected.
Conclusion : This study has allowed us to monitor laboratory blood gas testing performance very closely. With the 6 sigma methodology we have captured underperforming tests and investigated the reasons behind them

Keywords

Quality goal index 6 Sigma Total allowable error Westgard rule bias

References

  • 1- Bloom BM, Grundlingh J, Bestwick JP, Harris T. The role of venous blood gas in the emergency department: a systematic review and meta-analysis. Eur J Emerg Med. 2014 Apr;21(2):81-8. https://doi.org/10.1097/mej.0b013e32836437cf
  • 2- Ochs M, O’Brodovich. The structural and physiologic basis of respiratory diseases. In: Kendig and Chernick’s Disorders of the respiratory tract in children 8th edit. WB Saunders Company, Philadelphia, 2012;35-74.
  • 3- Ziegenfuß T, Zander R. Understanding blood gas analysis. Intensive Care Med. 2019 Nov;45(11):1684-1685. https://doi.org/10.1007/s00134-019-05688-w
  • 4- Davis MD, Walsh BK, Sittig SE, Restrepo RD. AARC clinical practice guideline: blood gas analysis and hemoximetry: 2013. Respir Care 2013;58:1694-703. https://doi.org/10.4187/respcare.02786
  • 5- Barthwal MS. Analysis of arterial blood gases a comprehensive approach. JAPI 2004;52:573-6. 3.
  • 6- Culver BH. Acid-base balance and control of ventilation. Eds. Albert RK, Spiro SG, Jett JR. İn Clinical respiratory Medicine, Philadelphia 2004.pp.99-106
  • 7- Fraser CG. The 1999 Stockholm Consensus Conference on quality specifications in laboratory medicine. Clin Chem Lab Med. 2015 May;53(6):837-40. doi: 10.1515/cclm-2014-0914.
  • 8- Coskun A, Inal TC, Serteser M. Six Sigma Projects and Personal Experiences. Croatia: InTech; 2011. http://dx.doi.org/10.5772/679
  • 9- Nevalainen D, Berte L, Kraft C, Leigh E, Picaso L, Morgan T. Evaluating laboratory performance on quality indicators with the six sigma scale. Archives of Pathology & Laboratory Medicine. 2000;124(4):516–519. https://doi.org/10.5858/2000-124-0516-elpoqi
  • 10- Thomas V, Desai PB, Mithrason AT. Evaluation of clinical biochemistry laboratory performance using sigma metrics. Int J Clin Bio chem Res. 2018;5(4):604. http://dx.doi.org/10.18231/2394-6377.2018.0128
  • 11- Sten Westgard, Hassan Bayat, James O Westgard. AnalyticalSigmametrics: A review of Six Sigma implementation tools for medical laboratories. BiochemMed (Zagreb) 2018;28(2):020502. https://doi.org/10.11613/bm.2018.020502
  • 12- Neufassung der “Richtlinie der Bundesärztekammer zur Qualitätssicherung labor medizinischer Untersuchungen – Rili-BÄK”. Dt Aerzteblatt 2014;111:A1583–618.
  • 13- Westgard JO, Westgard SA. Establishing evidence-based statistical quality control practices. Am J Clin Pathol. 2019;151:364-70https://doi.org/10.1093/ajcp/aqy158
  • 14- Kumar BV, Mohan T. Sigmametrics as a tool for evaluating the performance of internal quality control in a clinical chemistry laboratory. J Lab Physicians. 2018;10(2):194-99. https://doi.org/10.4103/jlp.jlp_102_17
  • 15- Koshy JS, Raza A. Sigma metrics in quality control- An innovative tool. Int J Clin Biochem Res 2021;8(4):253-259. https://doi.org/10.18231/j.ijcbr.2021.055
  • 16- Ustundag-Budak Y, Huysal K. Application of Sigma Metrics and Performance Comparison Between Two Biochemistry Analyser and a Blood Gas Analyser for the Determination of Electrolytes. J Clin Diagn Res. 2017 Feb;11(2):BC06-BC09. doi: 10.7860/JCDR/2017/23486.9259.
  • 17- Xia Y, Xue H, Yan C, Li B, Zhang S, Li M, et al. Risk analysis and assessment based on Sigma metrics and intended use. Biochem Med (Zagreb). 2018;28:020707 DOI: 10.11613/BM.2018.020707

Year 2025, Volume: 16 Issue: 2, 174 - 181, 10.04.2025

Çoskun Çavuşoğlu

https://doi.org/10.31067/acusaglik.1590729

Abstract

References

  • 1- Bloom BM, Grundlingh J, Bestwick JP, Harris T. The role of venous blood gas in the emergency department: a systematic review and meta-analysis. Eur J Emerg Med. 2014 Apr;21(2):81-8. https://doi.org/10.1097/mej.0b013e32836437cf
  • 2- Ochs M, O’Brodovich. The structural and physiologic basis of respiratory diseases. In: Kendig and Chernick’s Disorders of the respiratory tract in children 8th edit. WB Saunders Company, Philadelphia, 2012;35-74.
  • 3- Ziegenfuß T, Zander R. Understanding blood gas analysis. Intensive Care Med. 2019 Nov;45(11):1684-1685. https://doi.org/10.1007/s00134-019-05688-w
  • 4- Davis MD, Walsh BK, Sittig SE, Restrepo RD. AARC clinical practice guideline: blood gas analysis and hemoximetry: 2013. Respir Care 2013;58:1694-703. https://doi.org/10.4187/respcare.02786
  • 5- Barthwal MS. Analysis of arterial blood gases a comprehensive approach. JAPI 2004;52:573-6. 3.
  • 6- Culver BH. Acid-base balance and control of ventilation. Eds. Albert RK, Spiro SG, Jett JR. İn Clinical respiratory Medicine, Philadelphia 2004.pp.99-106
  • 7- Fraser CG. The 1999 Stockholm Consensus Conference on quality specifications in laboratory medicine. Clin Chem Lab Med. 2015 May;53(6):837-40. doi: 10.1515/cclm-2014-0914.
  • 8- Coskun A, Inal TC, Serteser M. Six Sigma Projects and Personal Experiences. Croatia: InTech; 2011. http://dx.doi.org/10.5772/679
  • 9- Nevalainen D, Berte L, Kraft C, Leigh E, Picaso L, Morgan T. Evaluating laboratory performance on quality indicators with the six sigma scale. Archives of Pathology & Laboratory Medicine. 2000;124(4):516–519. https://doi.org/10.5858/2000-124-0516-elpoqi
  • 10- Thomas V, Desai PB, Mithrason AT. Evaluation of clinical biochemistry laboratory performance using sigma metrics. Int J Clin Bio chem Res. 2018;5(4):604. http://dx.doi.org/10.18231/2394-6377.2018.0128
  • 11- Sten Westgard, Hassan Bayat, James O Westgard. AnalyticalSigmametrics: A review of Six Sigma implementation tools for medical laboratories. BiochemMed (Zagreb) 2018;28(2):020502. https://doi.org/10.11613/bm.2018.020502
  • 12- Neufassung der “Richtlinie der Bundesärztekammer zur Qualitätssicherung labor medizinischer Untersuchungen – Rili-BÄK”. Dt Aerzteblatt 2014;111:A1583–618.
  • 13- Westgard JO, Westgard SA. Establishing evidence-based statistical quality control practices. Am J Clin Pathol. 2019;151:364-70https://doi.org/10.1093/ajcp/aqy158
  • 14- Kumar BV, Mohan T. Sigmametrics as a tool for evaluating the performance of internal quality control in a clinical chemistry laboratory. J Lab Physicians. 2018;10(2):194-99. https://doi.org/10.4103/jlp.jlp_102_17
  • 15- Koshy JS, Raza A. Sigma metrics in quality control- An innovative tool. Int J Clin Biochem Res 2021;8(4):253-259. https://doi.org/10.18231/j.ijcbr.2021.055
  • 16- Ustundag-Budak Y, Huysal K. Application of Sigma Metrics and Performance Comparison Between Two Biochemistry Analyser and a Blood Gas Analyser for the Determination of Electrolytes. J Clin Diagn Res. 2017 Feb;11(2):BC06-BC09. doi: 10.7860/JCDR/2017/23486.9259.
  • 17- Xia Y, Xue H, Yan C, Li B, Zhang S, Li M, et al. Risk analysis and assessment based on Sigma metrics and intended use. Biochem Med (Zagreb). 2018;28:020707 DOI: 10.11613/BM.2018.020707
There are 17 citations in total.

Details

Primary Language English
Subjects Analytical Biochemistry
Journal Section Research Articles
Authors

Çoskun Çavuşoğlu 0000-0001-9238-3878

Early Pub Date March 21, 2025
Publication Date April 10, 2025
Submission Date November 24, 2024
Acceptance Date December 5, 2024
Published in Issue Year 2025Volume: 16 Issue: 2

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EndNote Çavuşoğlu Ç (April 1, 2025) EVALUATION OF BLOOD GAS INSTRUMENTS WITH 6 SIGMA METHODOLOGY. Acıbadem Üniversitesi Sağlık Bilimleri Dergisi 16 2 174–181.
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